If your readers came to the conclusion that our hospital is providing exceptionally good care in spite of poor revenue from the largest insurance company, their perception is completely correct.

Is this an outrage? Absolutely, because we are talking about the future of the most important hospital in the world.

I am defining "the most important hospital in the world" as the hospital that will take care of you if you become acutely ill or injured.

As a physician who has worked in many hospitals in our area as part of my practice over 25 years, I can assure you that DCMH did not win this recognition by some fluke.

Our doctors, nurses and administrative people have been able to maintain the highest standard of medical and surgical care with lean budgets that don't allow for expensive frills like robotic surgery (now shown to cost more without better results).

We do not have services and specialities that go beyond the hospital's basic founding principles. The mission of DCMH is to provide essential services that protect and maintain our health and well being. Our hospital board, administration and the county board have resisted the temptation to expand and try to compete with nearby larger hospitals.

Since our small hospital has very efficiently focused on the most important, essential services, and done its job very well, the financial problems that we now face must be a reflection of the messed up health care finance system.

I am not talking about Obamacare.

The bitter controversy about Obamacare has given individuals and local leaders an excuse to ignore the most frightening part of health care reform: The effect it has on the most important hospital in the world.

My point is that Obamacare may or may not help our hospital meet your healthcare needs in the future but we should not just sit around and hope it will.

It is also apparent that there are state and local issues that are larger than Obamacare that demand our attention.

Not very long ago there was a very public and animated debate about whether DCMH should invest in our now wonderful campus and building. Even though there was disagreement, people cared and they were willing to participate in the dialog.

People stood up and acted like they owned the hospital. Community leaders led. We are now confronted with much bigger challenges to the availability of high quality local health care and nobody seems to notice. I think our leaders care about these issues, they just don't know how to go about talking about it without having Obamacare dragged into the conversation.

There are facts and perspectives that are missing from the article about Blue Cross that make that situation even more bothersome.

Blue Cross, Blue Shield of Michigan (BCBSM) has reported that "case adjusted cost" for care in the U.P. is one third the cost of care in Wisconsin.

That means for a patient with a specific diagnosis and treatment, including surgeries, BCBSM writes checks to doctors and hospitals in Wisconsin that are triple the amount they would pay for the same patient if the same care had been provided in any Upper Peninsula hospital.

You may be thinking that the sicker and more complicated people end up in Wisconsin making it cost more. Actually, what they mean by "case adjusted" is that those patient variables are factored in so it is an apples to apples comparison.

On top of this insult, DCMH is paid the least of all the hospitals in the U.P.

Because of the very high cost of care provided by Wisconsin hospitals and doctors, BCBSM has changed their insurance policies to try to financially encourage patients to use U.P. hospitals and they have recently hired a consulting firm to go around to U.P. hospitals to help them present a more attractive image to patients.

It has not dawned on BCBSM that our hospital and its doctors might be better able to meet the patients needs and expectations if they just paid more.

It would provide huge benefit to our hospital if BCBSM increased the payment level to just half of what they are paying for the same care in Wisconsin.

My point is DCMH is not begging for a handout from BCBSM, they are only asking for fair treatment.

BCBSM has a right to operate as it needs to but if their payment policies endanger the long term well being of our hospital we must protest.

What can we do? Start by asking questions.

Ask your doctor. Your doctor should care what is going on since he or she cares about your health.

There are no politics in the relationship you have with your doctor. There is no single correct answer about what should happen to our local hospital but everyone should be talking about it.

Ask the county board and hospital board. They don't know anything for sure either but they might try harder to figure this out if they know that we are interested.

Talk to your employer, especially if you employer makes decisions about your health care insurance. They need to know that you are paying attention and that you care about having the best local hospital for your children and grandchildren.

They might be interested to know that the cheapest insurance option may not be the best for our hospital in the long run.

Whatever you do, don't wait for the federal government to quit bickering about Obamacare.

If we wait that long it might be too late for the most important hospital in the world.